Tuesday, July 31, 2012

"Hi, can someone call me back? I
saw you in 2005, but changed to another doc because I didn't like
you. Anyway, that doc just moved away, and I'm out of Vicoden. Can you
please call some in for me until I can find another neurologist?"

Sunday, July 29, 2012

I've
tried several medications for Mrs. Hedhurtz, including Fukitol,
Painbegone, Nomigraine, Acefalgia, Gonehert, and Nopayn, all without
success.

I've done MRI's, MRA's, and a spinal tap on her. I sent her to an ophthalmologist.

I was frustrated. She was more frustrated. I wasn't having a lot of success helping her. And she seems like a nice lady.

So,
since you advertise yourself as a neurologist who specializes in
treating difficult headaches, and cite your 2 years of headache
subspecialty fellowship training, I decided to refer her to you. You
opened up shop near me last month, so I thought I'd give you a chance
to earn my referral business. Your marketing person dropped off some
cards here 2 weeks ago.

And yesterday I got your faxed note about her.

At
the beginning of your note it says that "I've reviewed Dr. Grumpee's
notes and tests in detail." That was your second lie (your first lie is
in calling yourself a headache specialist, or even a doctor). I also
loved the fact that you spelled my name wrong.

Your note ends with the following, which I've paraphrased.

"Impression:
Mrs. Hedhurtz suffers from chronic headaches. She's previously failed
trials of Fukitol, Painbegone, Nomigraine, Acefalgia, Gonehert, and
Nopayn.I suggest she be referred to an ophthalmologist. A spinal tap should also be considered.

For future treatment, I suggest she be started on a medication that she hasn't previously tried before.I've referred her back to Dr. Grumpee's care to follow my recommendations.Yours truly,

I. M. Worthless, M.D."

Thank
you SO much for your helpful advice. I'd normally say "thanks
for nothing", but what you've done doesn't even amount to that much.

As my late grandfather would have said, "this is the second time I've sent you a patient. First and last."

Saturday, July 28, 2012

The Waratah wasn't a fancy ship compared to the giants that crossed the North Atlantic. She was built for mixed-use (both freight and passengers) but still had fashionable features to keep her travelers comfortable. She worked the long (6-8 week) voyage between England and Australia, serving stops in South Africa along the way.

And 103 years ago today she disappeared. Without a trace.

211 people vanished with her. She'd stopped in Durban, South Africa, where one passenger disembarked as he felt she was top-heavy and unsafe. She left port later that day, never to return.

Cruising along the South African coast on July 27, 1909 she was passed by (possibly) 3 other ships, though identification was difficult. The Waratah, like many other ships of the era, didn't carry the newly invented telegraph equipment.

The area is known for monstrous freak waves, which can overwhelm and badly damage ships. One steamer reported seeing a ship coming up quickly, possibly on fire (though it could also have been a brush fire on land, which were common). A police officer patrolling the Transkei coast thought he saw a large ship offshore being battered in huge waves, finally rolling over and sinking.

She was expected to reach Cape Town on July 29, but never made it.

The Royal Navy quickly launched a search with 3 cruisers, without success. One of them (HMS Hermes) was so badly damaged by huge waves that she required extensive drydock repairs upon return.

Further patrols were sent out, both private and government sponsored. All together they covered 14,000 square miles of water of South Africa. Without any evidence of the Waratah.

Not a single verifiable trace has ever been found. A few sightings of what may have been bodies floating off the coast afterwards, or a non-identifiable chair cushion bobbing on the waves. All seen from passing ships, but no one stopped to get a better look. For all we know they were seaweed or aquatic objects.

Leads have come in sporadically over the years. In 1925 the pilot of a plane reported seeing a large vessel on the bottom, but searches of the area have since been unsuccessful. Similar searches of the offshore area where the officer reported seeing a ship sink have also found nothing.

Twice it was thought her wreck had been found, but on investigation they turned out to be other lost ships. One was a freighter sunk during World War II.

What could have happened?

The answer remains a mystery. She was considered a safe, well-built ship, and had received top ratings from government inspectors and insurance companies.

A great deal of investigation time was spent on descriptions of her stability, but in the end a board of inquiry was unable to find any clear evidence of her being unseaworthy.

103 years later and we're no closer to finding her, or learning the fate of 211 voyagers, than we were in 1909. Like U.S.S. Cyclops, this is a mystery I'd love to see solved.

Saturday, July 21, 2012

Because nothing says "handmade by skilled craftsmen" more than prepackaged pizza dough in a plastic tube, made by a huge food conglomerate, and stacked en masse on shelves in every grocery store in North America.

Next is this picture, taken on approaching Atlantic City. Where, apparently, the casino buildings are always standing erect and ready.

Back to the artisanal crap, we have this generic package from a generic warehouse club, where they apparently can't decide if their generic cookie of the month is blueberry, cranberry, or macadamia. Unless it has all three.

Saturday, July 14, 2012

I don't know him personally. I wish I did, as he seems like a helluva nice guy. He's a hospitalist, and in our occasional communications by email or blog comments seems to be pretty cool, and a damn good doctor. He's the kind I wish worked at my hospital.

In addition, Karl is also a great cook from what his family tells me. Every year he single-handedly whips-up some sort of major-league Mardi Gras feast. Never having been to Mardi Gras I have no idea what he's cooking, but if I was invited, and lived near you, Karl, I'd definitely come over (but I'd have to draw the line at crawdads- crustaceans just ain't my thing).

As you can see in the picture, Karl's sister was also kind enough to make him a Dr. Grumpy cooking apron for Christmas.

He's also built his own wooden boat. Not a model, but a real boat. Which is way beyond what I can do. My boat-construction abilities are limited to inflating a raft for the pool.

Unfortunately, for all the fact that Karl is a good person, doctor, and cook, he's been diagnosed with brain cancer, has been through chemotherapy, and is now home on hospice.

So, Karl, this post is dedicated to you. I'm sure you helped plenty of patients and their families over the years who never had a chance to thank you.

Not to mention helped patients of other neurologists, and because of my field's inherent lack of social skills, I suspect my neurobros didn't thank you either.

Since you're now on the other side of the bedrail, I want to thank you on all of their behalfs and wish you and your family the very best at this difficult time.

I also want you to know what an awesome sister you have, and how much she loves you enough to put me up to this. Your wife is in cahoots with her.

Friday, July 13, 2012

His name was Girard. He had back pain. That's all I remember about him.

On July 13, many years ago, he was the very first patient I ever saw on my own.

Working
without a net for the first time is terrifying. I'd survived 4 years of
medical school, 4 years of residency, and 1 year of fellowship to get
there. This is the goal I wanted. And when it finally came it scared the
crap out of me.

There was fear in medical school,
starting classes and later starting clinicals, and even more in
residency. But in both those cases there was always a back-up system-
more senior people who actually knew what they were doing. There was
also a herd-based support system: You were with plenty of other people,
all sharing the same challenges.

But here, after 9
years of training, it was just me and Girard. Even though his case was
simple, it's pretty damn scary to realize that YOU are the attending,
and if you screw up there's no one else to blame.

I
remember another patient that day started the visit by saying "I came to
Humungous Neurology because I heard you guys are the most experienced."
My inner voice said "you probably don't want to know this is my first day."

Throughout
medical school you saw the attending physicians as omniscient giants.
Suddenly you're one of them, and realize that they don't know
everything. And you aren't a giant.

Like everything
else, after a while it becomes routine. But trying to remember that
first day still helps to keep you on your toes.

I don't
remember how many patients I saw that first day. A handful compared to
what I see now. One of them is still with me. I think I told her a few
years later she was on my first day. I even got a hospital consult, a
lady who'd obviously had a stroke. I got lost in the hospital trying to
find her room, then sat in the MRI control room to see images, terrified
at the thought that if they were normal I'd have no idea what was going
on.

I've now spent an estimated 4,650 days of seeing
patients in one place or another, with a lot more to go. But the first
one was the scariest. And hopefully always will be.

Thursday, July 12, 2012

"Doc, because, sometimes I get headaches, and I also have trouble
remembering things, and it's like when your foot hurts, or you've just
slept with a bunch of girls and don't want to get tested, or you just got a
new car and repaired the roof. Do you know what I mean?"

Wednesday, July 11, 2012

I'm not joking. This is a somewhat bizarrely-named drug-company sponsored educational event where doctors can (remotely) listen to lectures about migraine pathology and treatment.

Personally, I think this could have been better named something like "Migraine Symposium." Because the current name sounds like we should all be sitting in the dark with icepacks on our heads in solidarity. And I sure as hell wouldn't want to join that.

But it's for a good cause, so let's all break out the triptans and party (no red wine or chocolate)!

I suppose one has to grateful such events aren't held for Viagra, Detrol, or Imodium.

Wednesday, July 4, 2012

"Fans, for the past two weeks you have been reading about the bad break I got. Yet today I consider myself the luckiest man on the face of the earth. I have been in ballparks for seventeen years and have never received anything but kindness and encouragement from you fans.

Look at these grand men. Which of you wouldn’t consider it the highlight of his career just to associate with them for even one day? Sure, I’m lucky. Who wouldn’t consider it an honor to have known Jacob Ruppert? Also, the builder of baseball’s greatest empire, Ed Barrow? To have spent six years with that wonderful little fellow, Miller Huggins? Then to have spent the next nine years with that outstanding leader, that smart student of psychology, the best manager in baseball today, Joe McCarthy? Sure, I'm lucky.

When the New York Giants, a team you would give your right arm to beat, and vice versa, sends you a gift — that’s something. When everybody down to the groundskeepers and those boys in white coats remember you with trophies — that’s something. When you have a wonderful mother-in-law who takes sides with you in squabbles with her own daughter — that's something. When you have a father and a mother who work all their lives so that you can have an education and build your body — it's a blessing. When you have a wife who has been a tower of strength and shown more courage than you dreamed existed — that's the finest I know.

So I close in saying that I might have been given a bad break, but I've got an awful lot to live for. Thank you."

-Lou Gehrig, terminally ill at age 36 with ALS (aka Motor Neuron Disease), in his retirement speech. He died less than 2 years later.

This post is dedicated to Spiritcove and Roy, facing ALS as best anyone can. This is likely the worst disease in neurology, if not all of medicine. It's been almost 200 years since the first published report on it, and effective treatment remains a mystery.

If you're looking for a cause to give money to, consider the ALS Association.

Monday, July 2, 2012

Did you think of someone drooling in a dimly lit institution? Or someone so sedated on their seizure medicines that they aren't capable of working?

Think again.

Yes, there are some patients who still fit that description. But they're rare. You want to know what most epilepsy patients look like? They look like YOU!

Yes, folks contrary to popular belief, epilepsy patients are out there living normal lives. And there's a lot of them. It's a disorder that affects 1% of humans. So imagine the Rose Bowl stadium in California. When sold out it holds roughly 90,000 football fans. And statistically speaking 900 of them have epilepsy. Some may even be playing on the field.

Very few diseases have been as maligned over time as this one has. The majority of early cultures attributed seizures to demonic possession. I'm sure many innocent epileptics were killed in horrible fashion because of this. Others saw it as an intentional punishment from the gods. The great Dr. Charcot, founder of modern neurology, reported that in 19th century France epilepsy patients were locked up in the same dark building used to house the criminally insane and mentally handicapped.

Detail from "Transfiguration" by Raphael (1516) showing a child possessed by demons. The boy's posture and eye deviation are typical of partial-complex epilepsy.

You don't have to look too far back in American history to find laws on the books that banned epilepsy patients from marrying or having children. In the mid-90's I even trained under a doctor who still believed that horseshit, and told young adults, just starting out in life, that they should never, ever marry or raise a family. That's a pretty damn devastating thing to do to someone.

Vilifying any person because of an illness is wrong, whether it's diabetes, hypertension, or cancer. But epilepsy is one in my specialty, and I'll make a stand for my patients.

I probably fight harder for the rights of my epilepsy patients than any other group. Several times a year I have to write a letter to a divorce attorney saying that a well-controlled seizure patient is perfectly capable of being a parent, because the ex is saying that it makes them a danger to kids. Or I have to reassure a family that a patient can drive, or work, or travel on a plane. Obviously, there are laws restricting some things, like driving, but the majority of patients follow them and are perfectly good drivers. Hell, they're likely a lot safer than many non-epileptic people behind the wheel.

So what brought on this rant?

Last week the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act (AKA Obamacare). Now this post is NOT about the PPACA. I know a lot of people feel strongly about it in both directions, and if you want to fight about it, go to a website where you can. Because it's not what I'm talking about, or giving an opinion on.

What pissed me off was the reaction of a radio talk show host (who's not a medical doctor).

U.S. Chief Justice John Roberts has epilepsy and (under treatment guidelines) is likely on medication for this (I'm not his doctor). Big deal. So are a lot of other people.

But, as usual, there are some who'd rather smear than respect an opinion. Conservative commentator Michael Savage went on record last week as blaming Roberts' vote on - surprise - his epilepsy treatment (!) saying his writings showed "cognitive dissociation." He noted that drugs used for epilepsy "can introduce mental slowing, forgetfulness, and other cognitive problems."

Yes, Mr. Savage, they can cause these problems. You can also find similar side effects listed for most blood pressure medications, statins, and many other drugs (which, given your age of 70, I suspect you take at least one of) yet I'm not going to say your comments are due to medications. The side effect list of any drug is HUGE. But that doesn't mean everyone who takes it gets them. Quite the opposite.

My point is this: You're certainly entitled to your opinion. But just because you disagree with a man, don't go blaming it on his medications or health. It's a step backwards for all the epilepsy patients out there trying to lead responsible lives in the face of biases like yours. And, I suspect, if he'd ruled the other way you'd never have made such comments.

Since you apparently don't feel people being treated for seizures are capable of making rational decisions or serving in a responsible capacity, I'm leaving you with a list of people who have (or are highly suspected to have had) epilepsy. Perhaps you've heard of some.

Last, I should also mention former congressman Tony Coelho, who has the disorder. He was the primary sponsor of the Americans with Disabilities Act (1990). As a young man he wanted to be a priest, but was banned from such by his epilepsy. He also lost his driver's license and health insurance because of the diagnosis.

During his first run for congress (1978, which he won) his opponent tried to paint him with the same insulting brush, asking voters how they'd feel if their representative was at a White House meeting and had a seizure. Mr. Coelho responded, "I knew a lot of people who went to the White House and had fits. At least I’d have an excuse."

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

Singing Foo!

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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.